外侧入路肘关节造影辅助治疗婴幼儿肘关节骨折  

Application of elbow arthrography through lateral approach in treatment of elbow fractures in infants

作　　者：史强 燕华 李旭[2] SHI Qiang;YAN Hua;LI Xu(Department of Sports Medicine,Xiangya Hospital,Central South University,Changsha Hunan,410008,P.R.China;Department of Pediatric Orthopaedics,Guangzhou Huaxin Orthopaedic Hospital,Shantou University,Guangzhou Guangdong,510507,P.R.China)

机构地区：[1]中南大学湘雅医院运动医学科,长沙410008 [2]汕头大学广州华新骨科医院儿童骨科,广州510507

出　　处：《中国修复重建外科杂志》2021年第1期82-85,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨外侧入路肘关节造影辅助治疗婴幼儿肘关节骨折的临床疗效。方法回顾分析2016年5月—2018年5月收治的24例婴幼儿肘关节骨折患儿临床资料。其中男14例,女10例;年龄2个月~3岁,平均1.8岁。受伤至入院时间1 h~7 d,平均6.7 h。术前患儿患侧提携角为(30.8±4.5)°(24°~41°);肘关节活动度为(128.5±4.5)°(125°~134°)。均采用外侧入路肘关节造影,其中肱骨外髁骨折10例,肱骨远端经骨骺骨折6例,新鲜孟氏骨折3例,桡骨颈骨折5例。根据骨折类型选择切开复位克氏针、闭合复位长臂管型石膏或经皮交叉克氏针固定治疗。结果患儿均未出现造影剂过敏等不良反应。术后均获随访,随访时间14~38个月,平均19.6个月。术后2例出现针尾周围皮肤激惹,拔出克氏针后症状消失。复查肘关节正侧位X线片示骨折端均愈合良好,无1例出现肘关节畸形、骨骺早闭等并发症。末次随访时患儿患侧提携角为(5.2±1.9)°(2°~8°),肘关节活动度为(137.1±4.7)°(133°~141°),均较术前显著改善(t=22.670,P=0.000;t=11.910,P=0.000)。根据肘关节Flynn临床功能评定标准,优22例,良1例,可1例,优良率95.8%。结论外侧入路肘关节造影能够明确判断婴幼儿肘关节面软骨损伤情况及骨折类型,最大限度减少误诊及漏诊的发生,并可指导治疗方法的选择。Objective To evaluate the effectiveness of elbow arthrography through lateral approach in the treatment of elbow fractures in infants.Methods The clinical data of 24 infants with elbow fractures admitted between May 2016 and May 2018 were retrospectively analyzed.There were 14 boys and 10 girls with an average age of 1.8 years(range,2 months to 3 years).The time from injury to admission ranged from 1 hour to 7 days,with an average of 6.7 hours.The preoperative carrying angle was(30.8±4.5)°(range,24°-41°),and the elbow range of motion was(128.5±4.5)°(range,125°-134°).Elbow arthrography through lateral approach was used in all cases,including 10 cases of humeral lateral condylar fracture,6 cases of distal humeral epiphysis fracture,3 cases of fresh Monteggia fracture,and 5 cases of radial neck fracture.According to fracture types,open reduction with Kirschner wire fixation,closed reduction with plaster cast fixation,or closed reduction with percutaneous Kirschner wire fixation were used.Results None of the children had adverse reactions such as drug allergy.All patients were follow-up 14-38 months,with an average of 19.6 months.The skin irritation around the needle tail occurred in 2 cases after operation,and the symptoms disappeared after the Kirschner wire was pulled out.The anteroposterior and lateral X-ray films of elbow joint showed that the fractures healed well and no mulunion at the fracture site or premature epiphysis closure was observed.At last follow-up,the carrying angle was(5.2±1.9)°(range,2°-8°)and the elbow range of motion was(137.1±4.7)°(range,133°-141°),which were significantly improved when compared with those before operation(t=22.670,P=0.000;t=11.910,P=0.000).According to Flynn clinical function evaluation standard of elbow joint,22 cases were excellent,1 case was good,and 1 case was fair.The excellent and good rate was 95.8%.Conclusion Elbow arthrography through lateral approach can clearly judge the cartilage damage of the elbow joint surface in infants,and minimize the occurr

关 键 词：婴幼儿 肘部骨折 关节造影 外侧入路 

分 类 号：R726.8[医药卫生—儿科]